The Electronic Multidisciplinary Team Note: Using the CCTM Logic Model to Improve Team Communication in a Cleft and Craniofacial Program

Background/purpose: Cleft and craniofacial teams are required to deliver a multidisciplinary treatment plan to each patient to comply with ACPA parameters of care. Additionally, the Centers for Medicare & Medicaid Services (CMS) have established EHR incentive programs to encourage hospitals to demonstrate meaningful use of certified electronic health record technology (CEHRT), including using CEHRT to communicate directly with patients. Finally, patients and their families expect and need to have access to the patient’s multidisciplinary treatment plan, preferably using electronic consumer tools. Our objective is to demonstrate how one center undertook a QI initiative using the CCTM logic model to deliver a multidisciplinary team note by using one tool to satisfy all three of these communication directives.

Methods/description: To increase staff and patient awareness of the patient portal, a contest was implemented amongst all registration team members to incentivize them to register patients to the portal from March through June 2018. 256 patients were offered portal access by registration staff. 78 (30%) of patients offered successfully signed up and gained portal access. During this time, clinic coordinators provided education to all staff on CCTM logic model and benefits of portal use through QI monthly meetings and email communication. By June 2018, team members were trained on how to offer patients an online patient portal account, access the team note via the EMR, and add their individualized plan. Clinic coordinators launched a pilot of six patient team notes per clinic using the EMR and communicated this to the team. Patients not already signed up for portal access are encouraged to do so by clinic staff nurses through verbal education and pamphlet during a clinic visit. After the patient has seen all designated providers, the team plan is completed and signed by each provider. Once signed, the team coordinator launches a communication to the family via the EMR’s patient portal for their review, which includes a copy of the finalized team note. 62 electronic team notes have been added to individual EMRs as of Sept 17, 2018. Of these 62 patients, 51 (80%) have registered for EMR patient portal access. Since implementation, the team notes overall portal use has increased by cleft and craniofacial patients to over 30% from less than 10%. Families have reported that the portal allows access to the cleft and craniofacial team plan and offers additional path of communication with the team for non-urgent concerns. All cleft team members are able to easily access and add their plan of care with limited disruption to workflow. Limitations of the portal are the exclusion of patients who are non-English speaking, lack access to technology, and wards of the state.

Learning outcome: Describe benefits of using CCTM logic model when implementing EMR patient portal to communicate with families and provide team note; describe how CCTM logic model can assist the multidisciplinary team to deliver high-quality, high- value communication to patients; and evaluate the impact of EMR communication on increased transparency and efficiency.